Stress Fracture

Stress Fracture

Stress fractures are tiny, hairline cracks in the bone caused by repetitive force that can occur in the lower extremities including the foot.  If left untreated stress fractures can lead to a complete break in the foot.

Signs and Symptoms

Stress fractures can show up as pain, swelling, redness and possible bruising.

Who's At Risk

  • Runners and other athletes who play basketball, tennis, or gymnastics.are most at risk. It's important for any athlete to increase their training schedule gradually.  
  • Increased activity in those who live a sedentary lifestyle: e.g. non-athletes who take up a new sport and push themselves too hard
  • Underweight women runners (see below)
  • Women with an eating disorder who develop amenorrhea
  • People with flatfoot or other biomechanical foot problems
  • Improper shoes
  • Post menopausal women who have developed osteoporosis

Underweight Women Runners

Are you an underweight woman runner? A new study out of Ohio State University found that underweight women runners are at higher risk for stress fractures.

Women with a BMI of 19 or lower were at higher risk than those runners with a higher BMI. Also this was the first study to show that it takes longer to heal from a stress fracture for those with a BMI of 19 or less.

Although it's been known for a long time that stress fractures are more common in low weight women athletes (particularly teens), it's great to have more evidence so that women can make better health decisions.

The researchers thought that the reason for the higher risk in low weight runners is that the lack of soft tissue sends the shock of the constant pounding back into the bone. They agreed that more muscle mass was needed.

This idea of more muscle mass is echoed by Barbara Drinkwater, Ph.D who has studied bone health in master athletes. Many runners are often under the misconception that running provides enough weight bearing exercise to prevent stress fractures. Although much of her research has been on older women who have gone through menopause, her advice of weightlifting to build more muscle mass could extend to low weight women as well based on this study.


After confirming the problem through X-rays or other imaging, stress fractures are usually treating by recommending rest and by immobilizing the foot. Surgery may be needed to stablize the stress fracture or to repair a stress fracture that has progressed to a fracture.

For information about other types of heel pain visit:

What's Causing My Heel Pain and What Can I Do About It?

If you're noticing any of the symptoms above, it's important to make an appointment right away with a foot and ankle surgeon. Call us at 206-368-7000 or make an appointment online.